Provider Demographics
NPI:1831283217
Name:MOLLER, RALPH L (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:L
Last Name:MOLLER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:PMG AT 8300 CONSTITUTION POB
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2200
Practice Address - Fax:505-291-2233
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-24
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Provider Licenses
StateLicense IDTaxonomies
NMA-110198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z1135Medicaid
E29993Medicare UPIN
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